9665 SW LAKESIDE DRIVE 9665 SW LAKE SIDE DRIVE
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CITY OF i IGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD, OREGON 97223
PHONE 639-4111
CCDNTRkJOR:
Pursuant to Section(s) of the Uniform Building Cade, the
following iterr,(s) require correcting:
'),3t e: --- Permit No. ------- --
Inspector
CALL FOR REINSPECTION
ADDRESS Q �+� �c�e� t PERMIT NC._
PERMIT CHARGE none
r,'i R J ,� ��, r CONNECTION FEE
PAID BY
TYPE OF BUICC I NG _�� .� 4� DATL- CONNECTED
Sr ! I F E RATE _ ---�� INSPECTION FEE 191
CnKTRACfOR PATO BY DATE
SIZ- OF CO,:'jrCTIO": A3SES5Mr NT PAID
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�a3v: 1n.S;;I,D! On Qe��e:P !J PCk,cAl;on ❑ rddl'ion ^J �;c'.i3n
CL: TRACTOR e!Aj CI'JA•k.. t"u(t.�. -_� 0:��r:E t o�wx-�►, ��.
ADr:,;c�cc; �.��� C{nArG�C�°'3 WORK AQDpGSS
PHOti ;,�. --�'�3.�(n —_ APPLICAi 11_ - •,
He;; Inpu; Razing (BTU . ip_irJ��� Vent Size An ---- Flue Site__
FUEL Ott_ 11 GAS ELECT ❑ OTH _R
ITEM NO. FEE ITEM NO. FE
For Issuancc_o' ?ermit _ �-�T ``-) _3 00 � Air Condition Compressor 15 to 30 H?
New • IJ�:ir-r 1G0,000_ETU ^_— � ` �`• � 4.OJ Air Handing lU,>700 CFN
i �_— ��
j N;ew 10�,OrJ0 5TU & over'-- �Y�--- 5.00 'Ai. Handliiwg Over 10,003 CFM 5.0
Floor =ur':ace - , _--_ -_-_� 4.00 Evapzsrative Cooler ��-3.0
Wall • Floor Suspended _ _ _..__�.. I 4.00 ---Range Vent Fact _
Install Vents Onlr— l__2.00 Vcn,Sytrem T_ — —' — 3.
Fte_^sir^Hrr.t & Cooling - 4.00_ _ _Hood Commercial �3
<•ir C7ndojian Ci
mp•t-;epr _Uncle►3 Hp—� 4.00 Commercial Duc; Systern
Air Con^i:lon Compressor 3 to 15 HP 150 — - --- "--- --y
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Ifs SP EC f0. S CO En TS—..___�___. -- — ------- --.— -----
: CITY E;U51r;F.Se, LICENSE REOUIREQ FOR ALl CONT R-CT 0 RS UR SUF3 CONTRACTORS
A?PROVEO E?1'_ _ _,—. _ --- _-_—. DATE �_-- ISSUED BY__— ___.-- OA E y� 19
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BUILDING PERMIT APPLICATION 11 Y TIGARD► DATE aux � 1,3
1HE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED LBUILDE: 1HONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYII!G PLANS AND SPECIFICATIONS. OWNERPHONE
LOT NO.
OWNER i �. — JOB ADDRESS i„� i_x'Kll: 1 • HOME 4.DDRESS _
— 4RCHITECT
ENGINEER
BUILDER ADDRESS ^ —_ DL'SIGNER
STRUCTURE CINEW ❑R_FM_ODEL0
❑ADDITION o,,PAIR _❑RENEWAL _ ❑FIRE DAMAGE ❑fEM01_ITION
❑ RFSiDENCE ❑COMM ❑EDUCATIONAL ❑GOVT_❑RELIGIOUS❑PATIO ❑CAR PORT ❑GAhAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDIT!ONAL USE C3 DESIGN REVIEW ❑COUNCIL.APPPOVED — ❑SIGNS_
OCCUPANQY LAND USE ZONE---: r HLDG.1 YPE.=_—FIFA ZONE— PLAN CHECK EY— — HEAT
aal% 410
: �w d�c�1lW1 tL&jUtjud u4kxw:_;e I b8tr;. _ __---- - --- ----
Q ,_LS?912_—_.— —FL9Q� ')A�_.: _.—_.HEIGHT - _ ._.--_M1�O.S i ORIE�"_�c,v__.AB[A� 1 No.B -I2g4QM '-- _y$L�E t !7 ij i
BUILDING DEPARTMENT SET BACKS FRONT 10 REAR LEFT SIDE RIGHT SIDE
etmit
LL-UQ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ?'ONINu
Flan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
— — WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
,)ub-LOtdi ALL APPLICARLE CODE; AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
— RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
Stale Tax LICENSE, SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND "EATING.
Total uL13 #2 sin(l.i
By
JyL.t� APPI (CANT (1P ACF_NT
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DATE INSP. TYPE INSPECTION FtEMARK3 PLUMBING DATE
Contractor -- i
�-� - 7 r � -- _ Permit No.
��.. , —.t�_� >�•.� _ - Rough-in
q Fixture
Final
HEATING —
�/ —
^ COrItf71Ct01 /�
Permit No. �� �f -3�" 7
Oil
-- --�.__.-
Rough-in -- - -
- Final
SEWER
— l'innl ---� --
- -!DRIVEWAY
— — Fine -- —
Storth Drainage
(Rain Drain)Final
Sidewalk
—_ Curb Pr Street Final —
Approach --- ..�---- --
BLDG.DEPT.FINAL TEMFr.R A R Y CERTIFICATE OCCUPANCY
G CERTMCATI' OCCUPANCY Final --- - —
I endscaping
Zoning rincl
v
,a - CITY' 7 ._ No
� � _G '_ CATiON ' ^RD �nrE G PERMIr AP .
..,F (INDE RSIGNE D uEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONF&I— V���4I/
(_-F A, SH,)kVN ANC A.PPROVFD IN TILE: 1�APArG Pt-ANS AND SPECIFICATIONS, Ow•aERPHONLUI NO
��
-'� Y�9 4 Aj14RE55.. .I�dJ.�s _i1YS r,_HOME ADDR lSS -
ARCHITECT
ENGINEER
ER _ ��// ADDRESS _ DESIGNER
UCTURE IE%iW _ ❑REMODEL —❑ADDITION _ElHEPAIR ` OFiENEWAL– ❑FIRE DAMAGE OE)FMOLITION
V6!,-)FN,-E- 000MM 0E DUCAT IONAL OGOV'T ❑RELIGIOUSDPATIO OCAN PORE ❑GARAGE ❑STOR .GE 05LAB [JFEIvCE
N_D 0MOVING ❑CONDITIONAL USE ❑\\ DESIGN RMOP _ ❑COUNCIL APPROVED _ OSIGNS _
7. n. —L AND USE ZONE ��_.BLUG TYPE jV –F IRE ZDNsa PLAN CFIECK BY� HEAT
-
_2.
1O -BEDROOMSE..1 l'7_(s
BUILDING DEPARTMENT J /O ''id LEFT SIDE ,'i RIGHT SIDE S /
SET BACKS FRONT REAR
" THIS PERMIT IS ISSUED SUPJECI TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Ian Check !� REGULATIONS AND ALL A"PLICABLE CODFS AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
ub ioial ALL APPLICABLE rODF.S AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
I-- REST"'r�TIVE COVENANTS, CONTRACTOR AND SUB CONTR,CTORS TO HAVF CURRENT CITY ouSINESS
tat? Tax LICENSE. SEPARATE PE RMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
oial
Y
APPLICANT Oq GENT
pproved _. ReceiFrt 'Jo. \ -- _ ---------
G.
—P''�Nf
ADDRESS